6 key metrics to optimize healthcare benefits.

Effectively managing healthcare benefits is crucial for HR and benefits leaders aiming to offer comprehensive, high-quality support to their employees. Measuring data-driven health benefits performance metrics like employee satisfaction, preventative care compliance, and point solution utilization is essential for evaluating and benchmarking the success of these benefits, allowing organizations to make informed decisions and improve their healthcare strategies. These metrics provide insight into workforce health, the efficiency of the health benefits program, and the financial impact on the organization.

Key healthcare benefits metrics.

To build a successful, cost-effective healthcare strategy, organizations must monitor key healthcare benefits metrics that reflect both financial performance and employee wellbeing. Tracking metrics such as healthcare spend, employee engagement, and benefits ROI allows HR and benefits leaders to evaluate program effectiveness and make data-driven decisions. These measures offer insight into what's working, what needs improvement, and how to align benefits offerings with organizational goals and employee needs.

1. Total healthcare spend.

Healthcare spend tracking is crucial for budgeting and financial planning, as it reflects the direct cost burden of providing health benefits. Budgeting should account for your organization's growth and rising cost trends. Analyzing healthcare spending can help organizations identify cost drivers, such as high rates of emergency room visits or expensive prescription medications, and develop strategies to manage these expenses more effectively.

2. Employee engagement.

+ Employee engagement measures the level of employee participation in the organization's health programs. Higher engagement levels often lead to better health outcomes and lower overall costs. When employees actively participate in wellness initiatives like fitness challenges or smoking cessation programs, they are more likely to adopt healthier behaviors, which can reduce the prevalence of chronic diseases and decrease healthcare costs. Engaged employees are also more likely to utilize preventive services, avoiding more severe health issues down the line.

3. Employee satisfaction.

Satisfaction with health benefits is a critical metric that influences overall health and productivity. Satisfied employees are more likely to utilize their health benefits effectively, contributing to overall health and productivity, and supporting related employee engagement metrics. For instance, if employees are happy with their mental health support options, they are more likely to seek help early, leading to better mental health outcomes and reduced absenteeism. High satisfaction levels can also enhance employee retention and attract top talent, making it a vital metric for competitive advantage.

4. Benefits return on investment (ROI).

ROI measures the financial return on healthcare investments. Ensuring that the organization’s healthcare benefits deliver value for the money spent is crucial. For instance, investing in a robust care navigation platform that helps employees find cost-effective healthcare solutions and avoid unnecessary procedures can significantly boost your benefits ROI calculation.

5. Preventive care compliance.

Measuring whether employees are adhering to recommended preventive care guidelines is crucial to the health of your team and your bottom line. Preventative care compliance ensures your workforce adheres to essential preventive screenings like mammograms and colonoscopies —that enable early detection of serious conditions. Early intervention not only improves health outcomes but also reduces the long-term cost of care. Monitoring this metric helps uncover care gaps and guides strategies to increase utilization of preventive services across your workforce. This metric helps identify gaps in care and develop strategies to encourage more consistent use of preventive services across your workforce.

6. Point solution utilization

It takes ample time and money to identify and implement high-quality healthcare point solutions, like telehealth services and mental health support, for your team. High utilization rates of these point solutions indicate that employees are taking advantage of specialized resources tailored to their needs which can lower healthcare costs and improve outcomes. However, if point solutions are not being utilized, it is crucial to identify why and whether or not they are worth the investment.

Challenges in optimizing healthcare benefits performance.

Despite the importance of data-driven health benefits performance metrics, many organizations struggle to optimize their health plan performance. Common challenges include:

Data silos: Fragmented data across different systems can prevent a comprehensive analysis.

Ineffective benefits communication: Poor communication channels can result in employees being unaware of or not fully understanding their health benefits, leading to underutilization.

Low employee engagement: Low engagement in health programs can lead to poor health outcomes and higher costs.

Complexity of care coordination: Managing care across multiple providers and services can be challenging and inefficient for your teams.

How to track healthcare benefits metrics effectively

To effectively track healthcare benefits, HR and benefits leaders should focus on three key areas: spend, utilization, and engagement. These areas reveal what’s driving costs, how benefits are being used, and whether they’re delivering value.

• Healthcare spend: Use consolidated analytics platforms to track claims data, pharmacy costs, and vendor reporting. Identify trends like ER overuse or high-cost prescriptions.

• Employee engagement: Monitor participation in wellness programs, surveys, and care navigation tools to assess involvement and impact.

• Benefits ROI: Evaluate the return on specific programs by comparing costs with outcomes—such as improved health, reduced absenteeism, and higher satisfaction.

Set clear benchmarks, monitor preventive care compliance, and review point solution utilization by team or demographic. Regular data reviews help uncover care gaps, improve outcomes, and ensure your benefits strategy stays aligned with employee needs and business goals.

How care navigation elevates health benefit plan performance.

Care navigation helps organizations improve preventative care compliance, optimize point solution utilization, and enhance benefits ROI calculation. Here's how:

Directs members to high-value care.

Care navigation services help employees find the best care options at the most affordable prices. By offering personalized guidance, Rightway ensures that employees avoid unnecessary and expensive treatments and instead receive high-value care. They also identify high-quality, in-network providers and recognize when members are behind on preventive care or need to visit a primary care provider. This approach lowers costs and improves outcomes. 

Creates a better healthcare experience.

Healthcare navigation solutions provide a seamless and supportive healthcare experience for your teams. When members have healthcare needs, they have access to a health guide who can direct them to high-value care, like preventive care and other wellness programs, or answer their questions. The comprehensive support through a care navigation platform boosts satisfaction by taking the work off each member’s place during their time of need.

Provides tailored support for you and your teams.

Health navigation services optimize the use of healthcare resources unique to your organization such as telehealth, mental health support, and other point solutions. Healthcare navigators guide employees toward these services and follow up to ensure they receive the necessary care. This proactive approach ensures that these resources are used effectively, leading to better health outcomes and cost savings.

Rightway collaborates with benefits leaders to identify top healthcare-related metrics, KPIs, and goals for their workforce. Whenever a member has a healthcare question or need, they connect with their dedicated health guide through the Rightway app. Health guides provide care decision support, benefits education, steerage to high-quality providers, and billing advocacy based on the strategy outlined to drive your team’s benefits goals.

Rightway supports members at every step of their healthcare journey. Learn more about how Rightway's care navigation services engage your team, help you achieve your benefit objectives, and save you time so you can focus on your key goals.